1. When did you graduate from the medical college?
2. Do you have any additional qualifications apart from your primary medical qualification and general practice? 3. How long have you been practicing as a general practitioner (GP)?
4. What is your daily routine like? How many patients on an average, do you see every day? Diagnosis of Influenza
5. How do you diagnose Influenza? Are there set criteria for diagnosis?
6. What is the age group most commonly affected/ or that you most commonly see presenting at your practice with suspected influenza?
7. What are the most common presenting symptoms?
8. What do you think is the average duration of time between onset of symptoms and presenting at the practice?
9. How do you confirm a suspected case of influenza? (If the answer is via some sort of laboratory test, a possible follow-up question is– How soon do you receive test results?)
(The decision to ask question 10 will depend on answer to question 9. In the interview, if the GP says there is no method of confirming a case of influenza, question 10 may not be necessary).
10. Do you wait for confirmatory results before definitive influenza treatment commences? 11. What are the most common complications?
12. In which groups of patients do you observe complications the most? Have you observed any death due to influenza like illnesses? If yes, what would be the proportion?
Management of Influenza
13. What is the first line management of influenza? (Depending on answer, follow-up with question on the type of treatment – Antibiotics, Antivirals, etc.) What is the approximate cost of treatment of influenza like illnesses?
14. At what point do you decide to administer Antivirals/Antibiotics? What antivirals do you administer to patients?
15. Does management vary for different groups? (For example, children, adults, elderly or immunosuppressed patients?
16. Do you have to refer some patients to hospital? What are the factors that determine which patients you refer and which patients you don’t? (Prompts may be needed to investigate the impact of factors like age, gender, pregnancy status, co-morbidities, symptom severity, duration of symptoms, confirmatory test, etc.) 17. Are there any other circumstances in which you refer patients to acute care?
18. In some countries, national clinical guidelines are made available to clinicians to help them in their referral decisions. Is this something that you would find helpful? (Irrespective of whether they think such guides would be useful or not, explore further to gain an understanding of ‘why’ they think in this way; if they say that they would find guidelines useful, ask what would they ideally like to see in such a guide)
19. What if national guidelines on influenza treatment, management and referral were be introduced? How would you feel about this?
20. How much involvement do you have once you’ve referred the patient? Is there any follow-up care after the patient has left the hospital?
21. Do you provide any preventive advice to patients and their families? (If preventative advice is provided, ask in what form such as leaflets, verbal advice etc.)
Impact on the practice
22. Does the approach todiagnosis and management of patients presenting with influenza-like illness change during known epidemics/pandemics? If so, how and why?
Clinical Vignette Questions
1. A girl child of 3 years has been brought in by her parents. She has been irritable for the past 2
days and not feeding properly. Her parents report that she felt feverish (they haven’t checked her temperature) and she has been crying constantly. They have been giving her Calpol syrup for one day based on a recommendation by the local pharmacy.
a) Based on these symptoms, what do you think is the most likely diagnosis?
b) Would you request any laboratory investigations (blood tests, x-rays etc.) for such a case?
d) Will you advise a follow-up visit for this patient?
2. A 27 year old male accompanied by his wife consults the doctor. He has been feeling lethargic and weak for the past 3-4 days with body ache, headache and nausea. He has felt feverish and faint but has not checked his temperature. He has been taking ibuprofen and paracetamol for the past 2 days. He does not have a runny nose but his throat feels slightly sore. His eyes have been watery.
a) Based on these symptoms, what do you think is the most likely diagnosis?
b) Would you request any laboratory investigations (blood tests, x-rays etc.) for such a case?
c) What treatment would you recommend?
d) Will you advise a follow-up visit for this patient?
e) The patient’s wife rings up 1 day later saying that her husband is too weak to get out of bed
and has a productive cough with yellowish phlegm and severe breathlessness. What would you advise?
f) If you encountered such a case during a known influenza pandemic period, would your
approach change?
g) If you were told this patient had a history of asthma and had suffered asthma exacerbations
requiring hospitalisation in the past, would your approach change?
Appendix 2: Characteristics of participants